Global, regional, national, and local burden of COVID‐19 with inequality analysis across 920 locations, 2020–2021
Author(s)
Type
Journal Article
Abstract
Although the COVID‐19 pandemic has profoundly reshaped global health systems, a comprehensive and standardized quantification of its direct health burden across multiple spatial scales, particularly during its initial and most severe phases in 2020 and 2021, has remained lacking. Here, we present the first global‐to‐local estimation of the direct COVID‐19 burden during this period based on a repeated cross‐sectional design and secondary analysis of population‐level data using the Global Burden of Disease (GBD) 2021 analytical framework. We evaluated key measures of health burden for each year separately and assessed temporal changes to capture evolving patterns and disparities across 920 locations spanning five spatial hierarchies: global, regional, national, subnational, and local. The analysis includes 204 countries and territories, 77 international regions (e.g., the Commonwealth), 20 subnational regions (e.g., North England), and 618 local units (e.g., London). By integrating coarse‐grained (e.g., global and regional) and fine‐grained (e.g., national and local) estimates, we identified substantial spatial and socioeconomic inequalities in incidence, prevalence, mortality, disability‐adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Both age‐standardized and age‐, sex‐, and location‐specific estimates were generated. Leveraging the robust epidemiological modeling capabilities of the GBD framework, along with inequality metrics, including the slope index of inequality (SII) and the concentration index of inequality (CII), we uncovered pronounced disparities not only across countries and regions but also within them. Our findings underscore that aggregated regional data could mask potentially substantial cross‐national disparities and national aggregates could similarly obscure subnational and local differences. This has profound implications for understanding the distribution of long COVID risk, improving pandemic preparedness, and guiding equitable public health policy. Ultimately, this study provides an unprecedented evidence base to inform global‐to‐local health system strengthening and support data‐driven equity‐focused responses to future public health emergencies.
Date Issued
2025-09-01
Date Acceptance
2025-06-14
Citation
Med Research, 2025, 1 (2), pp.179-200
ISSN
2998-4963
Publisher
Wiley
Start Page
179
End Page
200
Journal / Book Title
Med Research
Volume
1
Issue
2
Copyright Statement
© 2025 The Author(s). Med Research published by John Wiley & Sons Australia, Ltd on behalf of Changsha Baiyi Garden Biotechnology Co., LTD. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
10.1002/mdr2.70013
Publication Status
Published
Article Number
mdr2.70013
Date Publish Online
2025-06-25